{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:00:04Z","timestamp":1789999204641,"version":"4.0.1"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The rising number of older adults in India has led to increased healthcare needs and financial challenges secondary to high out-of-pocket expenditure (OOPE). Understanding the extent and impact of OOPE among community-resident older adults is crucial for developing equitable health policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A mixed methods study was conducted among 364 older adults in Arimbur Gramapanchayath, Kerala. Quantitative data on healthcare expenses were collected using a pretested proforma, and qualitative interviews were conducted with participants reporting higher OOPE. Descriptive and thematic analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The mean monthly OOPE for outpatient care was INR 1,379, while the average annual OOPE for hospitalization was INR 26,094. Many participants (59.4%) lacked health insurance, and 76.8% of them preferred private healthcare. Qualitative findings indicated the presence of issues related to accessibility and availability of specialist care when needed. Financial insecurity adversely impacted the healthcare of older adults and at times led to the neglect of healthcare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Older adults experience substantial financial strain due to healthcare costs, with inadequate insurance and reliance on private services. Strengthening of public healthcare services and efforts to reduce OOPE will help in scaling up senior care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijcm.ijcm_975_25","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:02:51Z","timestamp":1789750971000},"page":"857-862","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Financial Burden of Out-of-pocket Health Expenditure among Older Adults in Rural Kerala: A Mixed Methods Study"],"prefix":"10.4103","volume":"51","author":[{"given":"Sruthy Kalathil","family":"Babu","sequence":"first","affiliation":[{"name":"Research Fellow, CGS, Kerala University of Health Sciences, Thrissur, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhadra Kudukkasseri","family":"Thrivikraman","sequence":"additional","affiliation":[{"name":"Dr Padiar Memorial Homeopathic Medical College, Chottanikkara, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V Raman","family":"Kutty","sequence":"additional","affiliation":[{"name":"Research Director, Amala Institute of Medical Sciences, Ernakulam, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KS","family":"Shaji","sequence":"additional","affiliation":[{"name":"Dean Research, Kerala University of Health Sciences, Ernakulam, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"R2-20260921","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.arr.2011.03.003","article-title":"Aging with multimorbidity: A systematic review of the literature","volume":"10","author":"Marengoni","year":"2011","journal-title":"Ageing Res Rev"},{"key":"R4-20260921","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1186\/s12913-024-11393-2","article-title":"The Ayushman Bharat Pradhan 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Puducherry","volume":"8","author":"Vasudevan","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"R12-20260921","first-page":"897","article-title":"Out-of-pocket expenditure and financial risk for healthcare utilization among elderly in a rural population of Haryana","volume":"12","author":"Pathak","year":"2023","journal-title":"J Family Med Prim Care"},{"key":"R13-20260921","first-page":"85","article-title":"Catastrophic health expenditure and poverty impact among older adults in India","volume":"21","author":"Ranjan","year":"2021","journal-title":"BMC Public Health"},{"key":"R14-20260921","first-page":"210","article-title":"Chronic disease burden and out-of-pocket expenditure in Kerala","volume":"64","author":"Kumar","year":"2020","journal-title":"Indian J Public Health"},{"key":"R15-20260921","first-page":"1062","article-title":"Socioeconomic inequalities in the use of healthcare services among older adults in India","volume":"21","author":"Srivastava","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"R16-20260921","first-page":"214","article-title":"Health expenditure patterns among urban poor in India","volume":"64","author":"Sharma","year":"2020","journal-title":"Indian J Public Health"}],"container-title":["Indian Journal of Community 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